Pt education

[Melclin]

What role do you believe we have in patient education?

I often find myself waffling on to patients, teaching them about this or that.

EG 1. Teaching a patient who finished chemo 3 days ago about their anti-emetics, hydration and options available in the community to assist them.
EG 2. Pts with SVT or other rhythm issues about their ECGs and about the terminology involved with their condition (because its frustrating when people say things like Oh yes I've had several heart attacks, but what they meant was that they had 5 short runs of SVT in hospital last week).
EG 3. Head injury advice in minor head knocks, medication side affects, OT and assisted living requirements etc etc.

I'm sure there are more and I'm certainly not alone in doing this. So it got me thinking about the value of formalising this kind of thing and about connecting it to formal patient education programs in the community.

As I've often mentioned people call more often than not because they lose the ability to cope with healthcare issue, not because they necessarily believe its a medical emergency. Other than often being important in medical emergencies, I think this sort of thing helps to build coping capacity in the population.

We did some great interdisciplinary round table discussions about case studies and various healthcare issues at uni. We put a student paramedic, med student, student nurse, OT, midwife and physio in a room with an issue and it was amazing how many deficits in knowledge their were about what the others did and what we learnt about how we can work together.

Questions
1. What do you think the value of this sort of informal education is? Do you do it yourself? What sort of examples/gems do you have from your own practice?

2. In what ways do you think paramedics could work with other healthcare agencies/professionals to improve patient education. Eg. You've been to a diabetic pt a few times and identified a deficit in their knowledge about their condition that is causing troubles. Perhaps you've tried to informally educate them yourself. Could we improve the informal education with say brochures (eg we already have brochures on coping with grief to give to grieving families) or care plans or perhaps something else? Or could we refer to community education class on diabetes? Could this class be held by a paramedic...one on light duties perhaps. How could we work with other HCPs to improve this kind of issue?

3. Would any of this help? Are you doing this already? Is their literature out their already on this that you know of?


All thoughts on patient and community education, building coping capacity and interdisciplinary co-operation welcome. Newbies, EMT-B, FRs, I mean paramedic in the general sense of anyone involved in community based acute care, get involved, I wanna hear everyone's opinion.

 

[Veneficus]

1. What do you think the value of this sort of informal education is? Do you do it yourself? What sort of examples/gems do you have from your own practice?

I think every provider has the obligation to offer education to all of their patients.

As for the second part, too many to recall as I end up doing this with just about every conscious person I am involved with.

2. In what ways do you think paramedics could work with other healthcare agencies/professionals to improve patient education. Eg. You've been to a diabetic pt a few times and identified a deficit in their knowledge about their condition that is causing troubles. Perhaps you've tried to informally educate them yourself. Could we improve the informal education with say brochures (eg we already have brochures on coping with grief to give to grieving families) or care plans or perhaps something else? Or could we refer to community education class on diabetes? Could this class be held by a paramedic...one on light duties perhaps. How could we work with other HCPs to improve this kind of issue?

I think patients like this benefit more from one on one education and help.

Brochures and classes in my experience are a waste of time.

3. Would any of this help? Are you doing this already? Is their literature out their already on this that you know of?

The hospitals I am involved with on both sides of the pond have both formal classes and brochures.

For the formal classes, with access being a barrier, the patients who show up are the ones who need the least help.

The brochures are printed in multiple languages, using simple terms, but lack the practical answers many patients need.

For example: "a diet low in carbohydrates should be followed." (the common follow up question is "what food is that?" which is not on the brochure.

If you want personalized results, you need personalized education.

If I had a penny for every patient who asked a provider "what does it mean to have this disease" and the provider responded with a pathophysiology lesson that didn't address the patient's concern at all, I would get to do a lot more traveling.

"The next time you are having a craving for McDs, you are going to feed it with some celery or carrots."

 

[Melclin]

....
I think patients like this benefit more from one on one education and help.

Brochures and classes in my experience are a waste of time.

....

The hospitals I am involved with on both sides of the pond have both formal classes and brochures.

For the formal classes, with access being a barrier, the patients who show up are the ones who need the least help.

The brochures are printed in multiple languages, using simple terms, but lack the practical answers many patients need.

If you want personalized results, you need personalized education.

So you might say that paramedics have a unique ability to access and provide one on one education with the very people who need it most.

Perhaps we should be targeting particular groups of acopic pts at an organisation level. eg, Bulletin: A recent PCR audit has shown that patients with condition x are calling 000 frequently in regards to avoidable minor complaints Y and Z. Please read the following x patient education package in order to better provide these kinds of patients with more information and more knowledge about appropriate care pathways.

 

[Veneficus]

So you might say that paramedics have a unique ability to access and provide one on one education with the very people who need it most.

I do say that actually...
For years.
Somebody will eventually figure out I am kind of smart and I don't say these things to make myself feel better.

Perhaps we should be targeting particular groups of acopic pts at an organisation level. eg, Bulletin: A recent PCR audit has shown that patients with condition x are calling 000 frequently in regards to avoidable minor complaints Y and Z. Please read the following x patient education package in order to better provide these kinds of patients with more information and more knowledge about appropriate care pathways.

Those are great ideas.

I would also try to tackle the big money spenders and find out which specific patients and populations are readmitted to the hospital most, why, and put something in place to prevent it.

I am also fond of safety seminars and geriatric/pediatric proofing homes.

Prevention is the best and cheapest medicine.

Don't worry about me, plenty of people to keep me busy still.

 

[MedicBrew]

This may have been already discussed, I haven’t searched it, but something like the APP’s and Community Paramedics may be a step in the right direction.

Been looking at Western Eagle County C.O. and Wake Co. EMS in S.C. who have programs that, on the surface, seem to be doing well for their Communities as far as reducing repeat transports and ED visits.

Patient education should be standard with each patient encounter, at least with the conscious ones.

 

[abckidsmom]

We did some great interdisciplinary round table discussions about case studies and various healthcare issues at uni. We put a student paramedic, med student, student nurse, OT, midwife and physio in a room with an issue and it was amazing how many deficits in knowledge their were about what the others did and what we learnt about how we can work together.

The strengths of interdisciplinary care are well documented. The resources that all of these people are going to be aware of are way more diverse and more likely to meet the needs of the patients.

I like the unique voice that medics bring to ID rounds that shows the team the reality of what's going to happen when grandma goes home and doesn't have the neb already set, or the house geri-proofed, or whatever...

Questions
1. What do you think the value of this sort of informal education is? Do you do it yourself? What sort of examples/gems do you have from your own practice?
[/QUOTE]

On every interaction, we owe it to our patients to educate them on what we're doing, what's happening physiologically, how their meds or behaviors or drinking or whatever are contributing to the problem at hand, etc. I teach people what 3 times a day means, what "with food" means, what "check your sugar" means, wound care, skin care, infant/child care, home safety, fire safety, car seat safety (my personal favorite safety topic), and so on, and so on.

Gems:

Just yesterday, I taught my patient who'd been smacked by his airbag how potentially life threatening it was for his 8 yo grand daughter to sit up front in the truck, I taught idiots whose cars had slid in the ditch how stupid it was for them to stand in the middle of the snow-covered road waiting for Jesus to come back, I taught a man with chest pain how anxiety contributes to his condition and that maintaining a low drama level in general was going to be helpful for him. I also made him aware of a senior citizen gathering place that his wife with alzheimer's would probably enjoy, free and available to the community every day.

Now we're up to lunch. I did about 12 more calls. Every. one. of those interactions involved teaching. I'm a talker, so I fill the time on our 30-45 minute transport chit chatting and identifying knowledge deficits (it's the nurse coming out in me).

2. In what ways do you think paramedics could work with other healthcare agencies/professionals to improve patient education. Eg. You've been to a diabetic pt a few times and identified a deficit in their knowledge about their condition that is causing troubles. Perhaps you've tried to informally educate them yourself. Could we improve the informal education with say brochures (eg we already have brochures on coping with grief to give to grieving families) or care plans or perhaps something else? Or could we refer to community education class on diabetes? Could this class be held by a paramedic...one on light duties perhaps. How could we work with other HCPs to improve this kind of issue?

I would love to provide automatic notification to people's primary care physicians of each time they call 911, like some ERs do with visits when the doc works with that hospital. A quick note included in the narrative when there's a specific need from the PCP that would actually get read would be great.

Lots of my patients go to my own PCP. Sometimes I find myself with someone who really needs a same-day appt, but this busy rural practice can't seem to get everyone in. I call, and use the right keywords I've learned to get the office to see just one more patient before they go home. Sometimes the physician listens to me and my assessment and will call in a refill of albuerol, or whatever is the problem, to save an ER visit. I really love when stuff like that works out because I can see that my brainpower and problem solving have saved money, time, infection risk, ER clogging, etc. If every medic had 2-3 interactions like this a week, that would be a lot of ER relief.

3. Would any of this help? Are you doing this already? Is their literature out their already on this that you know of?

This helps. It prevents 911 calls when people are truly ignorant of their options and resource, prevents ER visits when people take better care of themselves and promotes healthier interactions.

All thoughts on patient and community education, building coping capacity and interdisciplinary co-operation welcome. Newbies, EMT-B, FRs, I mean paramedic in the general sense of anyone involved in community based acute care, get involved, I wanna hear everyone's opinion.[/QUOTE]


I think this is everyone's responsibililty and if EMS wants to be recognized as the profession it is, it needs to be more formally included in the curricula, similar to how even diploma LPNs get lots of preaching about patient ed.

 

[Melclin]

I would also try to tackle the big money spenders and find out which specific patients and populations are readmitted to the hospital most, why, and put something in place to prevent it.

I am also fond of safety seminars and geriatric/pediatric proofing homes.

Prevention is the best and cheapest medicine.

We had some falls referral type things going on for a while in ambulance, but to the best of my knowledge they keept falling over...so to speak. I did a little bit of lit searching for a bloke at uni who was trying to get another referral thing off the ground, I should follow that up and see how it went.

Have you any experience with EMS based geriatric referral to falls teams, OTs etc?

I would love to provide automatic notification to people's primary care physicians of each time they call 911, like some ERs do with visits when the doc works with that hospital. A quick note included in the narrative when there's a specific need from the PCP that would actually get read would be great.


[/B


I think this is everyone's responsibililty and if EMS wants to be recognized as the profession it is, it needs to be more formally included in the curricula, similar to how even diploma LPNs get lots of preaching about patient ed.

That would be fantastic. Automatically sending the PCR to the GP in cases where the pt is left at home. I've written notes to GPs before explaining whats happened, that the pt has been seen by myself, that they didn't need to go to hospital but I felt it appropriate that they get his/her opinion. Its not really the same though. Notification with actual clinical information being sent through is a fantastic idea to close the cracks a little. This is something I'd love to look into more.

I agree that its something everyone should be doing. Bachelors as an entry level qualification goes a long way to achieving that I think.


How would you study an intervention like improving or systematizing pt education? The outcomes you really hope to achieve like reduced unnecessary EMS activation, reduced ED visits etc would be hard to link to any intervention.

 

[Handsome Robb]

We try to educate people any chance we get. Especially those with poorly managed chronic conditions.

We are so busy the we can't spend a ton of time on scene with every single patient unless we can justify it. We have resources available to us on the unit provided they are restocked to give people to refer them to the community health clinic along with other programs to help them with their prescriptions and other things. Also we can bring up issues with our supervisors and they are good about contacting the individual and helping point them in the right direction and getting them the help that they need.

I wish we had an APP program, they have been talking about implementing one but we will see how it works when and if it actually happens.

 

[Veneficus]

Have you any experience with EMS based geriatric referral to falls teams, OTs etc?.

None from EMS, except what I have read or discussed with people about community paramedicine.

One of my friends here is a doc and works at an urgent care, they started a "non-acute" ambulance so people could call that instead of 999.

She said that works out really well. Most of the patients who call are elderly and can't physically get to the urgent care for simple problems, prescription refils, etc.

I am told the most exciting call she went on was an autoamputated toe from uncontrolled diabetes.

How would you study an intervention like improving or systematizing pt education? The outcomes you really hope to achieve like reduced unnecessary EMS activation, reduced ED visits etc would be hard to link to any intervention.

just off the top of my head...

Track readmission rates.
Time of pt discharge to readmission for related problems.
Cost of onscene intervention vs. cost if pt was taken to ED. (including the cost of everything in the ED)
Number of patients transported or seen at the ED for falls attributed to non emergent medical conditions like slip/trip, trying to stand, etc.
man hours of education provision